Americans aged 50-74 constitute more than 20% of the population and more than 22% of U.S. smokers., There are 4.5 million smokers aged 65 and older. Older smokers are especially at risk from smoking because they have smoked longer, tend to be more highly addicted and are more likely to suffer from illnesses and conditions complicated by smoking. Yet, the benefits of quitting at any age now have been established. Thus, intervening with older smokers should be a priority. We propose to intervene among smokers aged 65-74 who receive transdermal nicotine (TN) patches through Pennsylvania's PACE program (Pharmaceutical Assistance Contract for the Elderly). This is an especially important population because it contains a large proportion of lower income older adults. Moreover, pilot survey data showed only 54% of PACE-enrolled TN users received initial patch use or quitting advice from their physicians or pharmacists, that only 2% used a formal outside treatment, and that 47% smoked while using the patch. The overall aim of the proposed study is to examine the incremental effectiveness of two promising interventions designed to boost adherence to recommended -patch use practices and effective self-help quitting methods/supports among older smokers prescribed TN. Subjects (N=765/group) will be assigned randomly to: (a) a "usual care" no treatment control group; (b)Clear Horizons (a tailored guide for older smokers) alone; or (c) Clear Horizons plus a series (5 reports and 2 cards) of personalized, tailored mailings to enhance their quitting skills, overcome their personal barriers, strengthen their intrinsic quitting motives, facilitate their progress through the stages of change, and encourage adherence to recommended TN regimens and practices. Mailed and-telephone assessments will be conducted 3, 6 and 12 months post-randomization to determine reactions to the intervention and smoking status, and to assess other variables related to TN use, smoking cessation and intermediate outcomes. The project research extends and builds on previous research with older adults and has the potential to improve the efficacy of TN for older smokers, increasing the proportion of older smokers who use TN properly and quit smoking. Results will provide direction for future pharmacy-based smoking cessation programs.